Negative Pressure Ventilation

The cuirass, rocking bed, and negative pressure respirator (iron lung) are among the featured devices.

PioneersPioneers
Pioneers
1854 Eugene Woillez, Spirophore1854 Eugene Woillez, Spirophore
1854 Eugene Woillez, Spirophore
In 1854, Eugene Woillez described the Spirophore, the forerunner of the Iron Lung. This negative pressure ventilator was hand powered by use of a bellows. In the era where fears of premature burial were prevalent, parents would sometimes insist that their stillborn babies be ventilated for long periods of time before being declared dead. It was also used for near drowning victims and for recovery from snake bites. In the case of snake bites, the patient was ventilated until the neurotoxins causing diaphragmatic paralysis were broken down, and recovery was assured.

The device included a hand crank for the operator to turn to power the unit and an adjustable neck collar. Woillez did not patent his device.
1864 Alfred Jones, 1st Patent1864 Alfred Jones, 1st Patent
1864 Alfred Jones, 1st Patent
Alfred E Jones of Lexington, Kentucky, obtained a patent for a negative pressure ventilator. He claimed it could cure conditions such as paralysis, rheumatism, weakness, asthma, bronchitis, and deafness.
1889 Braun's Infant Resuscitation Box1889 Braun's Infant Resuscitation Box
1889 Braun's Infant Resuscitation Box
Dr. Egon Braun, an Austrian physician, developed an early device used in infant resuscitation. After the infant was placed in a wooden box, the operator blew into the attached pipe to compress the infant’s chest. Air then escaped out of the pipe, causing a negative pressure that caused the infant’s chest to expand for inspiration. This was repeated at a rate to approximate a respiratory rate.
Image from Dennis Glover
1929 Phillip Drinker and Louis A. Shaw1929 Phillip Drinker and Louis A. Shaw
1929 Phillip Drinker and Louis A. Shaw
Dr. Phillip Drinker (1894-1972) and Dr. Louis Agassiz Shaw (1886-1940) were faculty members at Harvard University when they developed the first negative pressure “respiration apparatus” in 1928. They applied for a patent in 1929 and received it two years later.

The bellows was capable of generating pressures of -60 cmH2O and rates between 10 and 40 breaths per minutes. The pressure was initiated at -18 cmH2O and the patient was asked to count out loud as pressure was adjusted until the patient could no longer speak.
Dr. Phillip DrinkerDr. Phillip Drinker
Dr. Phillip Drinker
Dr. Phillip Drinker, one of the inventors of the "iron lung" demonstrates how to adjust the neck collar on the unit.
Image from the archives of Children's Hospital of Boston.
1931 John Emerson improved the "iron Lung"1931 John Emerson improved the "iron Lung"
1931 John Emerson improved the "iron Lung"
John Haven “Jack” Emerson (1906-1997) an American biomedical inventor did extensive work on the negative pressure respirators which became known as “iron lungs”. Emerson’s first unit was completed in 1931 and was lighter, quieter, and cost half the price of Drinker and Shaw’s device. Emerson was sued by Philip Drinker and Harvard University for patent infringements. However, Emerson won the case and Drinker’s patents were declared invalid. Emerson’s “Old Number One” iron lung is displayed in the Smithsonian Institution.
Image from Dennis Glover
PoliomyelitisPoliomyelitis
Poliomyelitis
PolioPolio
Polio
Multiple epidemics of poliomyeltis, also known as infantile paralysis, occurred in the United States in the first half of the twentieth century. Although the name would lead one to believe it was a disease of young children, infantile paralysis affected adults as well.

In 1916, over 2,000 of the 6,000 polio deaths reported that year in the United States occurred in the city of New York. Franklin Delano Roosevelt contracted polio in 1921, leaving his legs paralyzed. In 1938, the March of Dimes fundraising campaign was established to fight and treat polio/infantile paralysis. Millions of dollars of the funds raised were directed to research to develop a polio vaccine.

When the polio epidemic peaked in 1952, nearly 58,000 cases were reported with over 21,000 of those being paralytic cases. Ventilatory support could be provided by the cuirass, rocking bed, and iron lung.

In 1949, three types of poliovirus were identified. In 1952, Jonas Salk tested the initial vaccine on himself and his family. Polio vaccine trials began in 1954 but were suspended in 1955. In 1960, Sabin's vaccine, was licensed. By 1963, a vaccine effective against the three types of poliovirus, was available.

Among celebrities who survived polio are actress Mia Farrow, guitarist Gene Simmons of Kiss, singer Neil Young, Archbishop Desmond Tutu, actor Donald Sutherland, actor Alan Alda, saxophonist David Sanborn, violinist Itzhak Perlman, movie director Francis Ford Coppola, and Katherine Jackson, (mother of Michael, Janet, LaToya,…).
1940s Polio Ward1940s Polio Ward
1940s Polio Ward
Image from Steve & Mary DeGenaro
Polio Treatment OptionsPolio Treatment Options
Polio Treatment Options
Several options for the management of polio for in the 1950s are show in this photo: the cuirass, the rocking bed, and the iron lung.
Image provided from the archives of Children's Hospital in Boston
The-Iron-Lung-and-PolioThe-Iron-Lung-and-Polio
"The Iron Lung and Polio"
"The Iron Lung and Polio" video, produced by Mark Rockoff, MD is used with permission from Boston Children's Hospital.

VentilatorsVentilators
Ventilators
1914 Artificial Respiration Machine1914 Artificial Respiration Machine
1914 Artificial Respiration Machine
A physician at County General Hospital in Denver, Colorado claimed to have developed this “artificial respiration apparatus” in 1914. This unit pre-dated Drinker and Shaw’s device by over a decade. The inventor of the 1914 device did not file for a patent.
Image from Steve & Mary DeGenaro
1929 Drinker & Shaw's Respirator1929 Drinker & Shaw's Respirator
1929 Drinker & Shaw's Respirator
Dr. Philip Drinker and Dr. Louis A. Shaw developed an early negative pressure respirator. A patent was applied for in 1929 and granted in 1931.
1930 Drinker Respirator1930 Drinker Respirator
1930 Drinker Respirator
When this photo was taken on September 19, 1930, this Drinker iron lung at St. Luke’s Hospital in Chicago, Illinois reportedly was the only one in existence between Chicago and California.
Image from Steve & Mary DeGenaro
1930 Drinker Iron Lung1930 Drinker Iron Lung
1930 Drinker Iron Lung
Image from Steve & Mary DeGenaro
1931 Emerson's Early Iron Lung1931 Emerson's Early Iron Lung
1931 Emerson's Early Iron Lung
The Emerson iron lung was less expensive and had other added innovations from the previous Drinker and Shaw negative pressure ventilator. The bed could be slid in and out to provide patient care. In addition, side ports allowed access to the patient within the tank to provide care while contained in the tank. The early models were painted blue, later models were yellow.
Image from Mark Anderson
1930s1930s
1930s
Image from Steve & Mary DeGenaro
1930s1930s
1930s
Image from Steve & Mary DeGenaro
1930s1930s
1930s
Image from Steve & Mary DeGenaro
19381938
1938
In this 1938 photo from Alton Illinois, the caption states “An 18 year-old bride with infantile paralysis, Mrs. Myra Rothe is kept alive by an iron lung at St. Joseph’s Hospital here. Physicians gave her a fighting chance to recover.”
Image from Steve & Mary DeGenaro
1940 Homemade Iron Lung1940 Homemade Iron Lung
1940 Homemade Iron Lung
In this photo dated March 15, 1940, the caption stated "Homemade Iron Lung failed to save life despite ingenuity of father. James Bailey, 25 watching operation of device on his baby son, Paul which kept him alive two days. The infant died soon after. Bailey fashioned the apparatus from an oil barrel, washing machine parts, and rubber tire tubing.”
Image from Steve & Mary DeGenaro
1942 Directory of Respirator Resources1942 Directory of Respirator Resources
1942 Directory of Respirator Resources
Resources for construction of new negative pressure respirators became scarce as World War II escalated. In 1942, the National Foundation for Infantile Paralysis published a directory identifying the names and locations of facilities with iron lungs respirators.
Image from Steve and Mary DeGenaro
1940s Pediatric Iron Lung1940s Pediatric Iron Lung
1940s Pediatric Iron Lung
Image from Steve & Mary DeGenaro
Pediatric Iron LungPediatric Iron Lung
Pediatric Iron Lung
An "iron lung" designed for pediatric patients is shown.
Image provided from Boston Children's Hospital Archives
1930 Drinker Iron Lung1930 Drinker Iron Lung
1940s
1940s Emerson Iron Lung1940s Emerson Iron Lung
1940s Emerson Iron Lung
The early Emerson iron lung models were painted blue, later models were yellow.
Image from James Sullivan
Dräger Iron Lung PrototypeDräger Iron Lung Prototype
Dräger Iron Lung Prototype
The prototype of the Dräger Iron Lung with a torpedo tube frame is shown. By 1947, the company was producing iron lung ventilators constructed from scrap metal left over from World War II.
Image from Dräger
1947 Emerson Lung1947 Emerson Lung
1947 Emerson Lung
1947 Emerson Lung ad.
Image from Steve & Mary DeGenaro
1947 J.H. Emerson's Dome Patent1947 J.H. Emerson's Dome Patent
1947 J.H. Emerson's Dome Patent
J.H. Emerson received a patent in 1947 for an enclosure that fit over the patient’s head delivered intermittent positive pressure in the dome when the body chamber was opened for routine care and therapy.
Late 1940s Iron Lung with DomeLate 1940s Iron Lung with Dome
Late 1940s Iron Lung with Dome
Image from Steve & Mary DeGenaro
1950s Dome for Drinker-Collins Respirators1950s Dome for Drinker-Collins Respirators
1950s Dome for Drinker-Collins Respirators
Image from Steve & Mary DeGenaro
1950s Dome1950s Dome
1950s Dome
Image from Steve & Mary DeGenaro
1950 Patent for Lung Collar1950 Patent for Lung Collar
1950 Patent for Lung Collar
In 1947, J.D. Akerman filed a patent application for a closure collar for the respirators. The patent was granted in 1950.
View of a Neck CollarView of a Neck Collar
View of a Neck Collar
View of a neck collar from inside an iron lung.
Image from Colleen Schabacker
1950s Multi-Person Ventilator1950s Multi-Person Ventilator
1950s Multi-Person Ventilator
In the 1950s, Dr. James Wilson developed a multi-person negative pressure ventilator at Boston Children’s Hospital.
Four Person ChamberFour Person Chamber
Four Person Chamber
A unit that could house up to 4 four patients requiring negative pressure ventilation at the same time was offered at Boston Children's Hospital in the 1950s.
Image from the archives of Children's Hospital of Boston
Interior View of ChamberInterior View of Chamber
Interior View of Chamber
The interior of the 4 person "iron lung" chamber is shown.
Image from the archives of Children's Hospital of Boston
4 Person Ventilator4 Person Ventilator
4 Person Ventilator
This unit allowed four persons to be housed in one large negative pressure ventilation chamber. The device was located at Boston Children's Hospital.
Image from the archives of the Children's Hospital of Boston
1952 DIY Emergency Wooden Respirator1952 DIY Emergency Wooden Respirator
1952 DIY Emergency Wooden Respirator
The last major polio epidemic peaked in the United States in 1952. Due to the scarcity of available “iron lungs” around the country, a well-known magazine for “do-it-yourselfers” published blueprints for construction of an emergency wooden respirator.
Image from Glenn Tammen
1953 Poliomyelitis Epidemic Patients1953 Poliomyelitis Epidemic Patients
1953 Poliomyelitis Epidemic Patients
Because iron lungs were mostly available in large cities, family from small cities or rural areas often had to travel long distances to visit their family member in a hospital that had iron lungs available. The polio epidemic had just peaked when this photo was taken at Rancho Los Amigos Hospital in Downey, California.
1953 Duralmin Lung from Japan1953 Duralmin Lung from Japan
1953 Duralmin Lung from Japan
This 1953 photo shows Professor Hideo Itokawa opening the door of his duralmin lung, which reportedly was produced at one-third the price of similar models available in the United States.
Image from Steve & Mary DeGenaro
1955 Drinker-Collins Duplex Respirator1955 Drinker-Collins Duplex Respirator
1955 Drinker-Collins Duplex Respirator
Image from Steve & Mary DeGenaro
1950s Infant Iron Lung1950s Infant Iron Lung
1950s Infant Iron Lung
Image from Steve & Mary DeGenaro
1957 Mobile Iron Lung Ambulance1957 Mobile Iron Lung Ambulance
1957 Mobile Iron Lung Ambulance
In this May 1957 article, the emergency mobile iron lung ambulance of the Omaha, Nebraska Fire Department was featured.
Image from Steve & Mary DeGenaro
1950s1950s
1950s
1977 Don't Die On My Shift Published1977 Don't Die On My Shift Published
1977 Don't Die On My Shift Published
This non-fiction book chronicles the life of the author from the time of his initial bout with polio in 1952 through 1968. The book covers his life in an iron-lung in a hospital ward through his eventual discharge home receiving mechanical ventilation through a mouthpiece.

Don't Die On My Shift by William F. Sayers, published by Major books, July 1977. ISBN # 0-89041-161-1.
Image from Gayle Carr
Portable RespiratorsPortable Respirators
Portable Respirators
1953 Transport in an Iron Lung1953 Transport in an Iron Lung
1953 Transport in an Iron Lung
In this November 5, 1953 photo, Lauren Carlson, age 24, was being transported in an iron lung to a specialized care center, the Sister Kenny Unit at the Oakland County Contagious Hospital in Farmington, Michigan. Depending on the model, iron lungs weighed between 1000-1800 pounds.
Image from Steve & Mary DeGenaro
1953 Lightweight Unit for Military Transport1953 Lightweight Unit for Military Transport
1953 Lightweight Unit for Military Transport
In July 1953, the military began using a lightweight unit made of aluminum alloy and plastic. The unit weighed only 150 pounds, approximately 1/10 the weight of standard iron lungs. In this photo, a soldier who contracted polio was being airlifted from Walter Reed Hospital to a Michigan hospital closer to his home.
1957 Haverland's Patent1957 Haverland's Patent
1957 Haverland's Patent
In 1957, William H. Haverland was granted a patent for the lightweight, “portable mechanical lung”.
1950s Military Transport1950s Military Transport
1950s Military Transport
Image from Steve & Mary DeGenaro
Early PortaLungEarly PortaLung
Early PortaLung
Early Model of Portable RespiratorEarly Model of Portable Respirator
Early Model of Portable Respirator
early model of a portable "iron lung".
Image from Mark Anderson
Opportunites for ResponautsOpportunites for Responauts
Opportunites for Responauts
Responaut is a term coined to describe an individual permanently dependent on mechanical ventilation.

When Robin Cavendish of England contracted polio at age 28, he enlisted the assistance of Professor E. Teddy Hall to help him design a ventilator built into a wheelchair to allow mobility for himself and fellow "responauts", those individuals who were previously confined to iron lungs or ventilators in the hospital setting. The first prototype of the ventilator-wheelchair was released circa 1962. Cavendish developed other devices to improve the quality of life for others with disabilities and actively advocated for those with neurological and neuromuscular impairments until his death in 1994.
Pneumowraps & PneumobeltsPneumowraps & Pneumobelts
Pneumowraps & Pneumobelts
1948 F.T. Wallin Patent Filed1948 F.T. Wallin Patent Filed
1948 F.T. Wallin Patent Filed
In 1948, Francis Wallin filed an application for a “portable respirator” which included a garment and shell combination. The patent was awarded in 1948.
Late 1940s Cuirass ShirtLate 1940s Cuirass Shirt
Late 1940s Cuirass Shirt
In order to increase effectiveness, in some cases the cuirass was applied to the chest, and an air-tight garment was placed over the cuirass to make a seal. Garments such as ponchos and rain suits that were tight fitting at the waist, neck, and arms helped achieve an air-tight seal for effective ventilation.
Image from Steve & Mary DeGenaro
Mid-1950s PneumoWrapMid-1950s PneumoWrap
Mid-1950s PneumoWrap
1960 Emerson Raincoat1960 Emerson Raincoat
1960 Emerson Raincoat
A rigid case is placed over the thorax and the patient is enclosed in an airtight plastic garment such as a poncho or rain suit. An electric motor that cycles on and off is used to create suction pressure to the airtight enclosure. This negative pressure is applied to the thorax and generates chest expansion. To be effective the system must be airtight. Although less cumbersome than an iron lung, it still was confining and restricting for the patient.
Image from Steve & Mary DeGenaro
1958 Pneumobelt1958 Pneumobelt
1958 Pneumobelt
The Pneumobelt was introduced in 1958 and is alternatively known as an intermittent abdominal pressure ventilator (IAPV). It consists of an inflatable bladder that is secured over the abdomen. The patient must be seated to use the device. An electrically powered motor sends air to the bladder intermittently which expands the bladder. When the bladder inflates, it compresses the patient’s abdomen and forces the diaphragm to move upwards, aiding expiration. Inspiration is relatively passive as the bladder deflates, the diaphragm moves downward by gravity.
Trademark filed 1958 by Thompson Corp.
Pneumo-beltPneumo-belt
Pneumo-belt
This ad, which introduced the Conitech Multi-lung power unit for cuirass and the new Pneumo-belt, appeared in the June 1958 issue of the INHALATION THERAPY journal.
PneumobeltPneumobelt
Pneumobelt
CuirassCuirass
Cuirass
Like the iron lung, an electric motor was used to generate negative pressure. In this case the pressure was directed only to the patient’s chest, unlike the iron lung, where negative pressure was delivered to the entire body enclosed in the iron lung chamber. The motor was set to cycle and deliver negative pressure intermittently to achieve a respiratory rate. Negative pressure applied to the chest wall allowed for chest expansion and thus generated an inspiration. To be effective an air-tight seal was necessary. When the motor cycled off, the relief of negative pressure allowed for a passive expiration. Although current use is limited, there is some application for the chest cuirass particularly in neuromuscular patients and those patients with relatively normal compliance and airway resistance. The chest cuirass offers the advantage that ventilation is non-invasive and unless another indication is present, intubation or tracheostomy are unnecessary to deliver ventilation. Current models have active inspiration and expiration phases, and modern technology allows for molded plastics to be used for custom fitting of a cuirass to an individual patient’s chest configuration.
1928 Eisenmenger's Patent1928 Eisenmenger's Patent
1928 Eisenmenger's Patent
Beginning in 1920, Rudolf Eisenmenger began applying for patents in Europe for his “apparatus for producing or promoting breathing or respiration.” He applied for a patent for the device in the USA in July 1926 and was granted the patent in May 1928.
1939 Drinker & Collins1939 Drinker & Collins
1939 Drinker & Collins
In 1936, J.A. Nordin was awarded a patent for his invention of a “apparatus for producing artificial breathing or respiration.”
1941 Cuirass1941 Cuirass
1941 Cuirass
Image from Steve & Mary DeGenaro
1940s Cuirass Shell1940s Cuirass Shell
1940s Cuirass Shell
Image from Kerry George
1940s Cuirass1940s Cuirass
1940s Cuirass
The chest cuirass, a negative pressure ventilator, offered a few advantages over the iron lung. It allowed for better accessibility to the patient. In addition, since the entire patient wasn’t enclosed, it allowed the patient a little more in mobility and changes in position. However, in order to be effective, an air-tight seal still needed to be obtained, and this was somewhat difficult to achieve especially if the patient wasn’t in the supine position.
Image from Steve & Mary DeGenaro
1947 Dual Cuirass Respirator1947 Dual Cuirass Respirator
1947 Dual Cuirass Respirator
In March 1947, Charles Wilm filed a patent application for a respirator that could simultaneously power two chest cuirass respirators. The patent was granted on December 6, 1949 and assigned to the J.J. Monaghan Company.
Technicon Huxley RespiratorTechnicon Huxley Respirator
Technicon Huxley Respirator
The Technicon Huxley respirator pump and cuirass was introduced in the 1950s.
Image from the archives of Children's Hospital of Boston
1950s Cuirass1950s Cuirass
1950s Cuirass
Image from Steve & Mary DeGenaro
1950s Cuirass1950s Cuirass
1950s Cuirass
Image from Steve & Mary DeGenaro
1950s Cuirass Shells1950s Cuirass Shells
1950s Cuirass Shells
Image from Steve & Mary DeGenaro
1954 Cuirass1954 Cuirass
1954 Cuirass
The caption of this photo from the collection of Steve and Mary DeGenaro states “In this June 14. 1954 photo, Mrs. Betty Panceusz is home with sons Paul (3) and Gregory (4) and husband Adam after 2 years at Herman Kiefer Hospital in Detroit, Michigan”.
Image from Steve & Mary DeGenaro
1955 Emerson Chest Respirator1955 Emerson Chest Respirator
1955 Emerson Chest Respirator
1956 Animal Therapy1956 Animal Therapy
Image from Brian Walsh
Thompson VentilatorThompson Ventilator
Thompson Ventilator
The Thompson ventilator could be used with a cuirass. The ventilator was contained in a small "make-up" luggage case.
Image from Felix Khusid
1980s Puritan Bennett Thompson Cuirass1980s Puritan Bennett Thompson Cuirass
1980s Puritan Bennett Thompson Cuirass
Image from Kerry George
Rocking BedsRocking Beds
Rocking Beds
Rocking BedRocking Bed
Rocking Bed
The rocking bed, developed in 1932, tilted from head to foot at a rate approximating a patient’s normal respiratory rate. As the bed tilted head-down, the abdominal contents gently pushed on the diaphragm to augment expiration. As the bed tilted head up, gravity allowed the abdominal contents to move by gravity downward, and allowed the diaphragm to descend to augment inspiration.
1960 Rocking Bed and Iron Lung1960 Rocking Bed and Iron Lung
1960 Rocking Bed and Iron Lung
Image from Steve & Mary DeGenaro
1960 Rocking Bed1960 Rocking Bed
1960 Rocking Bed
Image from Steve & Mary DeGenaro
19641964
1964
In this November 3, 1964 photo from Dundee, Illinois, the caption states “ Mrs. William Ryan, 40, stricken by polio in 1962 lies in a a rocking bed. She runs an antique store and the Dundee March of Dimes. On her chest is a plastic respirator.”
Image from Steve & Mary DeGenaro
19661966
1966
This photo was dated July 1966 from Dallas, TX and captioned: “A Tenacious Hold on Life. Courageous is the best word to describe Mrs. Betty Erickson who has been in an iron lung for over 20 years.” She is pictured here in her rocking bed next to her iron lung.
Image from Steve & Mary DeGenaro
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